r/HealthInsurance • u/JulesSherlock • 8d ago

Medicare/Medicaid Anesthesiologist is billing $3700 even though insurance is telling them to stop.

My husband went to the emergency room due to food blocking esophagus. He had to have a gastroenterologist, push it on down. The anesthesiologist billed his insurance who refused it based on it being filed too late. Procedure was 3/8 and they billed 7/1. Then they billed him $3700, which is when he noticed the issue. Said insurance paid $0 and if he didn’t pay by 9/15 it would go to collections. He called his insurance (United Healthcare - Medicare) and they said they would call them the next day and have them refile it. He watched for it online and saw that it had been re-filed on 8/1 so he thought it was ok. Well, insurance denied it again. It says denied due to filing too late and do not bill member. Same as last time. So he expects to get a bill in the mail any day now.

I feel like we’re going in circles. How do we get off this ride if we do get the bill again?

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u/EamusAndy 8d ago

It is not your husbands fault the provider didnt bill timely. Thats on them.

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u/Whole_Bed_5413 8d ago

Interesting that physicians get months to file claims, yet insurance companies get years to claw back a retroactive denial. Right. It’s the physician’s fault. And what does the insurance company have to lise when the physician files later? Nothing. They get to hang on to money that they owe, interest free.

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u/EamusAndy 7d ago

You realize its actually the State that claws back claims retroactively right? And they have 7 years. Dont blame MCOs when it takes them seven years to do the due diligence that weve been telling them to do since 2018.

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u/Whole_Bed_5413 6d ago

Where did you learn insurance law? No. You’re 100% wrong. The only time that the state would be clawing back ANYTHING is if the patient was a Medicaid beneficiary or the state was otherwise funding the patient’s medical care.

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u/EamusAndy 6d ago

And that is why an MCO is allowed to claw back claims years later